Halo重力牵引在Ⅰ型神经纤维瘤病伴严重脊柱侧后凸畸形患者中的应用研究

Efficiency of preoperative Halo-gravity traction in severe kyphoscoliosis secondary to neurofibromatosis type Ⅰ

目的探讨术前Halo重力牵引(HGT)在Ⅰ型神经纤维瘤病(NF1)合并严重脊柱侧后凸畸形患者治疗中的应用价值。方法回顾性分析2007年7月至2016年5月在南京大学医学院鼓楼医院脊柱外科行术前HGT治疗的29例NF1合并严重脊柱侧后凸畸形患者的病例资料。其中男性17例,女性12例,年龄(13.7±2.9)岁。测量牵引前后的主弯Cobb角及最大后凸Cobb角,记录牵引前后的用力肺活量(FVC)与1秒用力呼气容积(FEV1)。采用配对t检验分析牵引前后的参数变化。结果29例患者HGT最大牵引重量为(12.2±2.8)kg,牵引时间(10.2±6.6)周。牵引前主弯Cobb角为(87.5±36.5)°,牵引后改善至(68.4±25.9)°,侧凸矫正率为(21.9±12.1)%(t=9.14,P<0.001);牵引前最大后凸Cobb角为(79.1±27.1)°,牵引后为(59.9±19.4)°,后凸矫正率为(20.2±14.1)%(t=8.55,P<0.001)。其中1例患者在牵引2周时出现右侧臂丛神经麻痹,减轻牵引重量后逐渐恢复。行HGT治疗后,FVC由(0.83±0.16)L上升至(0.89±0.19)L(t=1.48,P=0.12),FEV1由(0.72±0.16)L上升至(0.78±0.20)L(t=0.49,P=0.63),FVC预计值由(42.9±20.1)%改善至(46.9±20.5)%(t=0.98,P=0.33),FEV1预计值由(40.6±19.6)%改善至(43.6±25.8)%(t=1.24,P=0.22)。结论术前应用HGT治疗NF1合并严重脊柱侧后凸畸形可一定程度上改善患者脊柱畸形和肺功能,提高患者的手术耐受力。

ObjectiveTo evaluate the efficiency of preoperative Halo-gravity traction (HGT) in the treatment of severe kyphoscoliosis secondary to neurofibromatosis type Ⅰ (NF1).MethodsA retrospective review was conducted on patients with severe kyphoscoliosis secondary to NF1 at Department of Spinal Surgery, Drum Tower Hospital, Medical School of Nanjing University between July 2007 and May 2016. A total of 29 patients including 17 males and 12 females were finally enrolled and the age was (13.7±2.9) years. The Cobb angle of major coronal curve and global kyphosis were measured before and after HGT. The forced vital capacity (FVC)and forced expiratory volume in 1 second (FEV1) before and after traction were also recorded. The paired t test was used for comparison analysis.ResultsThe average maximum traction weight of HGT was (12.2±2.8) kg and the traction duration was (10.2±6.6) weeks. The coronal Cobb angle before HGT was (87.5±36.5)°, which improved to (68.4±25.9)° after HGT with a correction rate of (21.9±12.1)% (t=9.14, P<0.001);the average global kyphosis before HGT was (79.1±27.1)°, which improved to (59.9±19.4)° after HGT and the correction rate was (20.2±14.1)% (t=8.55, P<0.001). One patient had transient brachial plexus palsy which resolved completely after reducing the traction weight. After HGT treatment, FVC increased from (0.83±0.16) L to (0.89±0.19) L (t=1.48, P=0.12) and FEV1 increased from (0.72±0.16) L to (0.78±0.20) L (t=0.49,P=0.63). FVC predicted and FEV1 predicted improved from (42.9±20.1)% and (40.6±19.6)% to (46.9±20.5)% (t=0.98,P=0.33) and (43.6±25.8)% (t=1.24,P=0.22), respectively.ConclusionPreoperative HGT in the treatment of severe kyphoscoliosis secondary to NF1 can improve spinal deformity and pulmonary function to some extent, which can further benefit the patients by improving their surgical tolerance.